It’s all about the numbers: how economics is helping us to save sight in schools

Guillaume Trotignon, July 2019
Three school children from Ghana smiling outside their school.
Sightsavers' SHIP project screens school children for eye conditions and gives them glasses if needed.

In 2016, Sightsavers helped to develop and deliver the School Health Integrated Programming (SHIP) project in Cambodia, Ethiopia, Ghana and Senegal.  

As part of SHIP, teachers are trained to provide basic vision screening for their students and refer children with vision problems to a mobile team of optometrists. The SHIP projects in these countries have been a huge success, demonstrating how schools can be used to make sure children are screened for eye issues and intestinal worms, and given treatment where needed. To date, more than 57,000 children have received vision screening, exceeding our initial target of 40,000.

We know that children’s school performance is profoundly affected by their vision. I have first-hand knowledge of this: for many months I struggled at school because of poor vision and found it difficult to read the blackboard. This meant I became less confident about participating in class and frustrated at not being able to follow what was being taught. But this all changed when I was 10.  At a vision screening event at my school, I was diagnosed with myopia (short-sightedness) and started wearing glasses. School-based vision screening made a huge difference for me.

I now work at Sightsavers, in the health economics research team.  My experience at school means I can relate to the goals of SHIP.  But how could I contribute?

How can economics play a part?

The answer is economic evaluation. There is a major lack of information on the cost of vision screening, an issue which can prevent governments from allocating public resources to fund it. By using economics to generate evidence about the financial feasibility and affordability of SHIP, Sightsavers can help policy makers and planners to advocate or implement similar projects more efficiently.

So we used the SHIP pilot experience to estimate the cost of scaling up our school-based vision screening and treating uncorrected refractive error across our projects in Ghana and Cambodia.

As a starting point, we decided to look at the cost of two pilots to try to understand what resources were needed to implement a high-quality screening programme. We looked at how these costs were distributed to identify what would be the standard cost of implementing SHIP, using detailed financial data for each district.

After collecting the cost data, we developed a costing tool which, following SHIP’s guidelines, can be used to estimate the cost of carrying out school-based vision screening nationally in Cambodia and Ghana.

The results suggested that scaling up SHIP is affordable in these countries under the current health and education budgets. They also helped to build the financial case for a potential region-by-region scale up, if there is sufficient in-country capacity to deliver this.

There has been a lot of interest in the costing tool from our partners in Cambodia, particularly from the Ministry of Education, Youth and Sport (MoEYS), the Ministry of Health and The Fred Hollows Foundation. Together, we hope that the tool will help school-based vision screening to be included in the next education sector plan.

A child has her eyes tested at a school in Cambodia as part of the SHIP project.

What is the SHIP project?

The SHIP project screens children for health problems such as poor vision and worm infections, and distributes spectacles and treatments where needed.

More about SHIP
A school child in Ghana has his eyes tested.

Expanding to new countries

Following the success in Cambodia and Ghana, we are now using the SHIP costing tool to help launch SHIP in Liberia, where the pilot phase has just started. We hope this experience will improve the tool even further, to make sure it can be used in many more countries. We will also look at using the tool in Liberia to measure potential ‘economies of scope’, which means looking at cost savings that could be made by combining two health interventions (such as eye screening and deworming treatment), rather than carrying them out separately.

In Pakistan, we are looking for donor support to develop a SHIP project. An initial project will screen 200,000 children in 423 government schools in the next three years, to identify, refer and treat cases of childhood blindness, visual impairment, low vision and refractive error.

Interest in SHIP is growing. We have presented our work at several international conferences, including the Health System Research Conference in Liverpool and the Comparative International Education Society Conference in San Francisco, as well as holding a webinar as part of FRESH (Recovery, Engagement, Sustainable Development & Human Rights) 2018 coalition.

The International Health Economics Association Congress in Basel, on 13-17 July, will be another great opportunity for us to present the results of the economic evaluation, share our experience of using the costing tool in a range of countries, and learn from other economic evaluations and costing studies. This will help refine the tool, that can be used by anyone wanting to implement SHIP, and will help policymakers to make learning easier for many children…. It’s all hands on deck!

Funding for our Pakistan programme

There's a real need to expand the programme in Pakistan. For information about how you can help, contact us via email:

Munazza Gillani
Pakistan country director
[email protected]

Joe Weber
Institutional funding adviser
[email protected]



Guillaume Trotignon.Guillaume Trotignon
Guillaume is a research associate at Sightsavers, based in Berlin. He will be speaking about his work at the International Health Economics Association Congress in July.
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